ACA - Replacement?

[jmj11]

I'm tempted to delete every post with 'Republicans' or 'Democrats' in it, but the thread seems to have gotten back on track despite incipient label-based blame gaming.  Don't go back there; instead, focus on solutions without dragging political labels into it, please.

And  my intention was to stay within reason of what can be done, not wishful thinking. For example, I'm for a one payor system now, but it "ain't gonna happen" so I am not even going to discuss it. Maybe some of my ideas are too idealistic.

[Reality Check 2]

Speaking as one involved in health care - I feel helpless as to being able to render any real change in the ACA or anything else that involves Congress and politics at this point in the US.

 

Everything has been politicized and polarized to where there is no middle ground or even the desire for any one group to do anything but destroy what "the other side" wants. The great divide between haves and have-nots is so wide and disparate that no one really represents those stuck in the middle. 

 

The basic concept of Health doesn't exist. 

 

So, not to rain on your parade for real options - are there any that we, as healthcare providers, can realistically push forward? Who supports the healthcare providers? 

 

So I express ideals and basic beliefs in hopes that others feel the same way and we can build a wave out of it that can push toward those who actually have some power and can push forward ideas.

 

Currently, those in power have only the plan to ABOLISH and DESTROY that which their enemy created - the ACA. No plans for replacement - just repeal it - punish the creators and believers - no concern for the destruction it leaves behind.

[overthehorizen]

And  my intention was to stay within reason of what can be done, not wishful thinking. For example, I've for a one payor system now, but it "ain't gonna happen" so I am not even going to discuss it. Maybe some of my ideas are too idealistic.

I am going to give the classic "flip flopper" reply. I agreed with Medicare before I disagreed with Medicare. Actually, I love single payor healthcare. It already exists (as many others have pointed out) in the Medicare systems and VA system. What gets complicated is having providers and patients work in private health insurance systems and single payor systems.  I think single payor would be best for the country but it would need to be the only source of insurance. JMJ11 is right. It won't happen... UNLESS the private health insurance systems fails. Right now, the only way I see it failing is escalating premiums forcing and declining coverage which forces people out of the market. Then, the vaunted "public option" or "medicare for anyone under 65" becomes pretty exciting to a lot of people.  

[AMD]

Many friends with chronic health conditions who only have coverage due to the ACA are extremely concerned if they will be alive in a year from now.

Concerned or afraid? When congress comes for your right to healthcare in the middle of the night, I would be more than concerned. [emoji26]

 

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[Joe65D]

Concerned or afraid? When congress comes for your right to healthcare in the middle of the night, I would be more than concerned. [emoji26]

 

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Someone has a right to my labor? That's a scary thought

[AMD]

Someone has a right to my labor? That's a scary thought

No dear... that's not at all what I meant to imply. I'm saying the lack of transparency is a problem for everyone. Every provider is a patient at some point.

 

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[GetMeOuttaThisMess]

Concerned or afraid? When congress comes for your right to healthcare in the middle of the night, I would be more than concerned. [emoji26]

 

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There is no "right" to healthcare in the United States aside from Medicare, and even then one has to provide partial cost coverage for out-pt care/prescriptions.

 

Social responsibility? Yes. Right? No.

[ventana]

Hey folks

 

 

Let me just point out a few things

 

 

Government is ALREADY the biggest payor - something like 70% of people are already on some form of gov't insurance - Medicare, Medicaid, VA and the like.....

 

If we took away the 30% profit and gave the government the ability to negotiate drug prices as a sole entitiy we would save enough money to pay for basic insurance for everyone

 

We are the only first world county with out some type universal coverage and we rank near the bottom or at the bottom for every societal health marker except $$ spent where we are #1 by a HUGE margin

 

 

I honestly think the solution lies in a blended system

 

1) some type of universal health coverage that is basic coverage - frees up people to take time off, raise kids, travel with out having NO insurance - EVERYONE has this and reimbursements are set by a panel of 'providers' including a lit of PCP and internal medicine doc's (no longer dominated by subspecialists)

2) private market then offers nicer insurance - for a premium - -

 

We simply should not consider letting our county spend so much, health insurance companies make so much, and have such an ill society...

[Katera]

Hey folks

 

 

Let me just point out a few things

 

 

Government is ALREADY the biggest payor - something like 70% of people are already on some form of gov't insurance - Medicare, Medicaid, VA and the like.....

 

If we took away the 30% profit and gave the government the ability to negotiate drug prices as a sole entitiy we would save enough money to pay for basic insurance for everyone

 

We are the only first world county with out some type universal coverage and we rank near the bottom or at the bottom for every societal health marker except $$ spent where we are #1 by a HUGE margin

 

 

I honestly think the solution lies in a blended system

 

1) some type of universal health coverage that is basic coverage - frees up people to take time off, raise kids, travel with out having NO insurance - EVERYONE has this and reimbursements are set by a panel of 'providers' including a lit of PCP and internal medicine doc's (no longer dominated by subspecialists)

2) private market then offers nicer insurance - for a premium - -

 

We simply should not consider letting our county spend so much, health insurance companies make so much, and have such an ill society...

 

 

^^^  This!

[Reality Check 2]

http://thehealthcareblog.com/blog/2012/01/16/the-awkward-world-of-private-insurance-in-the-uk/

 

It is called BUPA and it has existed since 1948.

 

It could work but the US political system will never let it as long as for profit insurance companies line the pockets of politicians to keep legislation in their favor.

[Joe65D]

Rand Paul has an ACA replacement bill ready to go that focuses on Health Savings Accounts.

 

http://abcnews.go.com/2020/Stossel/story?id=3602579&page=1

[Reality Check 2]

Rand Paul has an ACA replacement bill ready to go that focuses on Health Savings Accounts.

 

http://abcnews.go.com/2020/Stossel/story?id=3602579&page=1

That sounds good but needs to cover preventative at 100% without the HSA or folks just won't ever come.

[Evolute]

Republicans. They think single payer is the end of the insurance industry. But really it saves so much money!

 

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Please site your sources......

[Joe65D]

That sounds good but needs to cover preventative at 100% without the HSA or folks just won't ever come.

 

I don't think so. My car insurance doesn't cover the cost of oil changes, spark plug replacement or brake pad replacements. Those are things that we budget for because we know what happens if we don't take care of our vehicles. Money really isn't an issue because most people understand that if you don't take care of your vehicle, you're out of luck, so you pay what you have to. If you're using your own money out of an HSA, you take more ownership of your health. You learn pretty quick that staying healthy can save you money. I know around here, you can get a physical with lipids for 60 bucks without insurance. Immunizations at CVS are around $100 a pop. 

[Evolute]

Hey folks

 

 

Let me just point out a few things

 

 

Government is ALREADY the biggest payor - something like 70% of people are already on some form of gov't insurance - Medicare, Medicaid, VA and the like.....

 

If we took away the 30% profit and gave the government the ability to negotiate drug prices as a sole entitiy we would save enough money to pay for basic insurance for everyone

 

We are the only first world county with out some type universal coverage and we rank near the bottom or at the bottom for every societal health marker except $$ spent where we are #1 by a HUGE margin

 

 

I honestly think the solution lies in a blended system

 

1) some type of universal health coverage that is basic coverage - frees up people to take time off, raise kids, travel with out having NO insurance - EVERYONE has this and reimbursements are set by a panel of 'providers' including a lit of PCP and internal medicine doc's (no longer dominated by subspecialists)

2) private market then offers nicer insurance - for a premium - -

 

We simply should not consider letting our county spend so much, health insurance companies make so much, and have such an ill society...

 

So I can just call in for a couple months? Ins pays? Raise kids? for 18 years? Ins pays? travel? that's called a vacation. Ins pays? You want insurance to pay for everything?

[GetMeOuttaThisMess]

I think that there needs to be an incentive for REASONABLE preventive services for which there has been shown to be a benefit. HTN, DM, CA screens, incorporate appropriate weight reduction, ETOH usage, and tobacco screening since these are all predisposing risk factors for same. Cheapest way to treat a medical condition is to prevent it. If correctable risks are identified then provide a reasonable time window incentive to modify (6 mos. - 1 year), and if not then penalize patient, or better yet, just establish a "guilt tax" to products. This would take some political cahones but could be quite effective. On the flip side it could establish a black market for same.

 

Example would be a McDonald's happy meal today which back in the 60's-70's was an adult serving. All the individual needs to do is buy two meals to get today's average serving size but they're also going to pay twice the price for it. Meal deal? Water or non-sweetened tea. You want a soft drink? Pay extra.

[PAMEDIC]

Please site your sources......

 

I'm confused by your post. Are you saying you need proof that single-payer systems tend to be cheaper than the current American system?

 

Even most opponents to single-payer systems will still admit they are cheaper. These systems have problems, but cost isn't usually one of the major complaints.

[Katera]

I don't think so. My car insurance doesn't cover the cost of oil changes, spark plug replacement or brake pad replacements. Those are things that we budget for because we know what happens if we don't take care of our vehicles. Money really isn't an issue because most people understand that if you don't take care of your vehicle, you're out of luck, so you pay what you have to. If you're using your own money out of an HSA, you take more ownership of your health. You learn pretty quick that staying healthy can save you money. I know around here, you can get a physical with lipids for 60 bucks without insurance. Immunizations at CVS are around $100 a pop. 

 

 

 

Good grief.....

 

1.)  Please stop comparing maintaining a CAR to maintaining good health?...It's really beneath the intelligence of the people on these boards.  The two scenarios are just laughably different.

2.)  Yes, some things can be prevented by a good lifestyle, but like ALL of you, I see patients every day that through NO fault of their own (or their lifestyle), wake up with some horrible health challenge.  A challenge that from then on will be a lifelong "Pre-existing condition".  Essentially screwing them out of future medical insurance if god forbid they ever lost "continuous coverage".

3.)  HSA's are greeeeeeaaaaat....So great, you can't use them to pay your premiums (other then Cobra), you still have to actually fund them, the "approved" use of funds from them are narrow in scope and subject to denial....etc etc etc.

 

 

Reading Rand Paul's and the other R's so called replacement for the flawed Obamacare, is like reading a line for line history description of what we had "before Obamacare".  

 

-Lifetime caps

-****off if you have a pre-existing condition

-State high risk pools which averaged 250% more per month in premiums then reg insurance, had lifetime and yearly caps and...wait for it....STILL made you wait 6-12 months for any pre-existing conditions.  That they were horribly underfunded I won't even mention...Ok, I just did.

 

 

As providers, I find the Physicians Tim Price and Rand Paul's Obamacare replacement suggestions utterly disgraceful.  What they want to return us to left more Americans to suffer and die bankrupt then I care to remember.  Having lived and practiced through it, I do not want to see it return.

 

And for those looking for my "facts"....I would refer you to the famous Harvard 2007 study of "Why Americans were going bankrupt".

 

Study link:  http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf

 

Cut and Paste from Study highlights:

 

 

•   62.1% of all bankruptcies have a medical cause.

• ●  Most medical debtors were well educated and middle class; three quarters had health insurance.

• ●  The share of bankruptcies attributable to medical problems rose by 50% between 2001 and 2007. 

 

 

 

And that is what they wan to return us to.  Just wow.....

[Joe65D]

"Please stop comparing maintaining a CAR to maintaining good health?...It's really beneath the intelligence of the people on these boards.  The two scenarios are just laughably different."

 

No thanks. Please stop complicating the problem. I wish people took care of themselves as much as they took care of their cars. My comparison was in response to having insurance cover maintenance visits 100% because people wouldn't pay for them. I think the comparison was fine. Obviously, the way medical practitioners are explaining health maintenance to patients isn't working if we're having the problems we have. Maybe the issue is pride if it's beneath us to use comparisons that the less intelligent among us would understand. Maybe I'm not as intelligent as some people here because I come from a background in construction and HVAC (as well as military medicine), but other than you calling it "beneath you" to discuss, you didn't explain why it doesn't work. The more I work on my car and the more I study medicine, the more convinced I am that a great mechanic would make an excellent med student. 

 

As for the study:

 

"In multivariate analysis, being uninsured at filing did not predict a medical cause of bankruptcy, while a gap in coverage did"

 

I'm not able to come to the same conclusion as you are reading the data. Sure, it sounds good to say "they had insurance at the time they filed bankruptcy," and conclude that the insurance itself was the problem, but that gap in coverage seems to be the big issue. Doesn't mention if it's by choice or not. Plus, phone surveys...

 

HSAs are transferrable, so I actually see that as a better solution to gaps in coverage since you can use an HSA while unemployed. It's kind of like when you get your tires...just kidding!

 

 

 

Anyways, I think hyperbole is more insulting to our intelligence than discussing things on a simpler level. But I will try and throw in some bigger words next time.

[Evolute]

I'm confused by your post. Are you saying you need proof that single-payer systems tend to be cheaper than the current American system?

 

Even most opponents to single-payer systems will still admit they are cheaper. These systems have problems, but cost isn't usually one of the major complaints.

 

In this case I'm not advocating for or against the single payer system. I'm simply stating that if one makes the broad statement that x is cheaper then y, they may want to provide supporting documentation. That's all...  

[Evolute]

I honestly think it would be a good investment to have mental health professionals who have extra training in somatization disorder in every community. When a patient is identified by the provider as a high consumer of healthcare (without objective disease) they would be required to have an somatization evaluation by one of the professionals, and if found to have the disorder, that they start a evidence-based treatment program. In the end that would save a huge amount of money.

 

I had a young lady yesterday arguing with me that she has MS. She has seen two neurologists (one being and MS specialist) say no. BUT her naturopath has now diagnosed her with MS. She has her on a bag full of supplements but also wanted her to find a neurologist who believes her. She wanted me to get a new MRI.  She is 28. I pulled up her radiological exams. Her last MS work up MRIs (brain and spine) were one year ago and normal. But, she has also had about 26 other radiological exams in the past 14 months for various reasons.  This is what I'm talking about. These people consume a huge amount of healthcare dollars.

 

I could not agree more. We also need more mhp's, and facilities to treat mental heath patients. IMHO our health care system is broken, but within the system, the mental health system is the most broken system.

[Boatswain2PA]

Republicans. They think single payer is the end of the insurance industry. But really it saves so much money!

 

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Saves so much money that our government is broke.

 

As a military PA, I agree with you. Not only as a patient, but as a provider knowing that all of my beneficiaries can receive whatever care I prescribe without the obstacle of cost is very refreshing. I literally never think about the financial side of medicine, reimbursement, RVUs, blah blah blah.

You never think about the financial side of medicine.  Neither do your patients.  And yet people think that single payer systems save money??  

 

Health insurance is a business where everyone benefits except the consumer. 

First rule in economics:  Two people who willingly exchange objects have both benefited from the exchange.  When you buy a purse for $100, you benefit because you think the purse is worth MORE than $100, and the seller benefits because they think the purse is worth LESS than $100.  The same thing could apply to medical insurance....if we weren't REQUIRED to buy it.  This allows the health insurance companies to raise their price.

 

Concerned or afraid? When congress comes for your right to healthcare in the middle of the night, I would be more than concerned. [emoji26]

 

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Where in the Constitution does it say you, or anyone, has a "right" to healthcare?  

 

That sounds good but needs to cover preventative at 100% without the HSA or folks just won't ever come.

Why?  

 

 

Back in the "old days" we paid for our health care visits, our medications, etc....and were able to buy (and afford) "catastrophic care" health insurance.

 

The further we moved away from this model, the more expensive healthcare became.  Now, since our single payor/CMS system pays for the vast majority of health care costs, costs are skyrocketing.

[HMtoPA]

 

You never think about the financial side of medicine.  Neither do your patients.  And yet people think that single payer systems save money??  

 

 

 

Well, I never said anything about saving money, but in many ways I think a single-payer system can be cheaper, because it de-incentivizes the ordering of unnecessary tests, procedures, and medications. The problem with my system is that many of my consultants are civilian and are billing TRICARE for services rendered, and every time I send out a patient I can almost hear the dollar signs ringing...it doesn't help that single-payor systems, in my experience, tend to produce an entitled patient population who don't seem to understand that the first-line acne therapy or mole removal they want from a dermatologist is exactly the same care that I could provide, without costing the government any extra dough. But I usually hold the line. :)

[UGoLong]

Since I was quoted, I guess it's time to respond. I have no answers, but some observations. As a provider, we all see patients whose lack of concern about their health has led to a health crisis. And we see patients who overuse a safety net program to their benefit.  All true. But not everyone does this. Most people play by the rules, watch their health in an era of conflicting (and often erroneous) Internet and Dr. Oz-like "health information," and they get sick anyway. I was one of them. 

 

Yes, it was different in the old days. My grandmother died of cancer in the 1950s. There was not real insurance for her but the sulfa drug they used cost $5 an injection. It didn't work, but it was cheap. Rooms weren't bad then either; hospitals initially started insurance because only the very sick came in and lots of beds were often empty. Kind of a time-share deal.

 

Costs have increased, but so has the technology. The $5 drug didn't save my grandmother, but apparently the $18,000 infusion saved mine. I salute the drug companies, but at the same time note that a $45 Viagra tablet costs only $5 in Canada. Between allowing safety net programs to negotiate for drugs and allowing Americans to buy Canadian drugs, there is definitely room for improvement.

 

The power of a free economy is great; it has led to many products and competition has led to lower prices. Unfortunately, when you are sick is not a great time to start casing out prices for things. It's not like Boatswain's purse: your life is at stake and time is of the essence. Regardless of whether you prefer single payer or lots of insurance companies, healthcare is more like a utility than it is a free market. Healthcare is something that we all need. The question is how to pay for it. I submit that, in many of our lives, we will be faced with a healthcare bill that we cannot afford to pay. That's why there is insurance. 

 

We can choose to let people die who don't have insurance and can't pay their healthcare bill. I submit that that has not been "the American way"; we don't leave our comrades on the battlefield either. If that is our position, then healthcare (and therefore access to health insurance) -- in some form -- is closer to a right than it is a privilege. 

 

For some people, HSAs might be an option, but, as you age and lose some of your mental acuity, that may not be a good option. You can have people buy insurance on the open market, but again -- unless you standardize some things -- only sophisticated buyers will be able to make an apples-to-apples comparison. Try reading almost any insurance policy and see what it's like.

 

All of this is a weighty problem and I suspect Congress is discovering that now that they actually have a chance to kill the ACA. As I heard on TV the other day, the dog has finally caught the car he was chasing. Not what?

 

All I ask is that we don't let ourselves be jaundiced by what we sometimes see at work. Life is not that cut-and-dried, as any of us who have had life-threatening diseases can attest. Talk to each other and have respect for one another. Most Americans are decent people who live their lives responsibly. We should be able to stop posturing and shouting and work this out. 

[PAMEDIC]

Saves so much money that our government is broke.

You never think about the financial side of medicine.  Neither do your patients.  And yet people think that single payer systems save money?? 

 

FWIW...

The Military Health System operates at around $5,500 per capita for its participants (which includes service members, spouses, dependents, and retirees).

The per capita cost for the nation as a whole is $9,000.